From the Guidelines
The recommended treatment for tinea capitis is oral antifungal therapy, with griseofulvin and terbinafine being the most widely used first-line treatments, as they have good evidence of efficacy 1.
Treatment Options
The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
- Griseofulvin is more effective against Microsporum species, while terbinafine is more efficacious against Trichophyton species 1.
- The dose of griseofulvin is 15-20 mg/kg/day for 6-8 weeks for children weighing less than 50 kg, and 1 g/day for 6-8 weeks for children weighing more than 50 kg 1.
- The dose of terbinafine is 625 mg/day for 2-4 weeks for children weighing less than 20 kg, 125 mg/day for 2-4 weeks for children weighing 20-40 kg, and 250 mg/day for 2-4 weeks for children weighing more than 40 kg 1.
Additional Measures
- Children receiving appropriate therapy should be allowed to attend school or nursery 1.
- Index cases due to T. tonsurans warrant screening of all family members and close contacts and treatment for those positive cases 1.
- Asymptomatic carriers with a high spore load may require systemic treatment 1.
- The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Accurate diagnosis of the infecting organism is essential. ... Representative treatment periods are tinea capitis, 4 to 6 weeks; Pediatric patients (older than 2 years): A dosage of 10 mg/kg daily is usually adequate (pediatric patients from 30 to 50 lbs, 125 mg to 250 mg daily; pediatric patients over 50 lbs, 250 mg to 500 mg daily, in divided doses). Adults: 0. 5 g daily (125 mg four times a day, 250 mg twice a day, or 500 mg/day). INDICATIONS AND USAGE Griseofulvin oral suspension, USP is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: ... Tinea capitis
The recommended treatment for tinea capitis is griseofulvin (PO), with a treatment period of 4 to 6 weeks. The dosage is:
- Adults: 0.5 g daily
- Pediatric patients (older than 2 years): 10 mg/kg daily, with the following dose ranges:
From the Research
Treatment Options for Tinea Capitis
The treatment for tinea capitis, a fungal infection of the scalp, typically involves oral antifungal medications. The following are some of the commonly used treatment options:
- Griseofulvin: considered the standard treatment for tinea capitis, especially in children 3, 4, 5
- Terbinafine: shown to be effective in treating tinea capitis, with a shorter treatment duration compared to griseofulvin 3, 6, 7
- Itraconazole: also used to treat tinea capitis, with a shorter treatment duration compared to griseofulvin 3, 7
- Fluconazole: may be used to treat tinea capitis, but its efficacy is still being studied 3, 4, 7
Efficacy of Treatment Options
Studies have compared the efficacy of these treatment options:
- Griseofulvin has been shown to have a high cure rate, with 96% of patients achieving cure in one study 4
- Terbinafine has been shown to have a cure rate of 88% in one study, and was found to be more effective than griseofulvin in treating Trichophyton tonsurans infections 4, 6
- Itraconazole and fluconazole have also been shown to be effective in treating tinea capitis, but their cure rates are generally lower than those of griseofulvin and terbinafine 4, 7
Safety and Cost of Treatment Options
The safety and cost of these treatment options are also important considerations:
- Griseofulvin has a long track record of safety and is FDA-approved for the treatment of tinea capitis in children 5
- Terbinafine, itraconazole, and fluconazole are generally considered safe, but may have more drug interactions than griseofulvin 5
- The cost of these treatment options varies, with griseofulvin and terbinafine being the least expensive 5